A multicenter study of perioperative and functional outcomes of open vs. robot assisted uretero-enteric reimplantation after radical cystectomy.

Open ureteroenteric reimplantation (OUER) of ureteroenteric strictures (UESs) is related to important morbidity. Robot-assisted ureteroenteric reimplantation (RUER) has been proposed to provide similar outcomes with lower morbidity. We aimed to compare perioperative and functional outcomes between RUER and OUER.

A retrospective multicenter study of 80 patients, who underwent 82 ureteroenteric reimplantations (17 OUER vs 65 RUER) at 8 institutions between 2009-2021 for benign UESs after radical cystectomy. All the open procedures were performed by the same center in order to compare the robotic approach with a standardized technique. Data were reviewed for demographics, stricture characteristics, and perioperative outcomes. Complication and stricture recurrence rates were compared between both groups.

Among 82 reimplantations, 44 were left sided (54%) and 12 bilateral (14%). Median time from cystectomy to diagnosis of stricture was 6 months (range 3-18). Baseline characteristics (gender, age, BMI, side, type of urinary diversion and previous abdominal radiotherapy) were comparable between RUER and OUER groups, except for ASA score and rates of prior robotic cystectomy. The 30-day overall postoperative complication rate was 37% in RUER compared to 70.6% in OUER (p = 0.026). Patients who underwent a RUER had statistically significant lower rate of intraoperative blood transfusion (0% vs 12%, p = 0.041), urinary tract infection (12% vs 53%, p < 0.001), bowel injury (0% vs 12%, p = 0.041) and high-grade complications (Clavien III-IV) (4.6% vs 23.5%, p = 0.031). RUER patients had shorter median length of hospital stay (3 days IQR[1-6] vs 6 IQR[3-9], p = 0.018) and lower readmission rate (4.6% vs 29.4%, p = 0.008). After a median follow-up of 23.5 months (8.7-43), 80% of RUER cases were stricture free compared to 90% of OUER (p = 0.42).

RUER achieved a success rate comparable to that of open revisions and may provide some advantages in terms of perioperative outcomes. Prospective and larger studies are warranted to prove its superiority compared to the standard open technique.

World journal of urology. 2025 Jan 16*** epublish ***

Tarek Ajami, Mireia Musquera, Joan Palou, Khurshid A Guru, Ahmed Aly Hussein, Daniel Eun, Abolfazl Hosseini, Josep Maria Gaya, Ronney Abaza, Umar Iqbal, Randall Lee, Ziho Lee, Matthew Lee, Carles Raventos, Alberto Breda, Fernando Lozano, Enrique Trilla, Francesc ViguƩs, Albert Carrion

Hospital Clinic de Barcelona, Barcelona, Spain., Department of Urology, FundaciĆ³ Puigvert, Autonomous University of Barcelona, Barcelona, Spain., Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA., Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, USA., Department of Molecular Medicine and Surgery, Department of pelvic surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden., Department of Urology, Ohio Health Dublin Methodist Hospital, Columbus, OH, USA., Department of Urology, Northwestern Memorial Hospital, Chicago, USA., Department of Urology, Hospital of Vall Hebron, Autonomous University of Barcelona, Barcelona, Spain., Department of Urology, Hospital Bellvitge, University of Barcelona, Barcelona, Spain., Department of Urology, Hospital of Vall Hebron, Autonomous University of Barcelona, Barcelona, Spain. .